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GJ-inspired health model expected to save on national level

By {screen_name}
Friday, February 3, 2012

A new report praises a national program based in part on practices in Grand Junction’s health care model.

The Center for Medicare and Medicaid Innovation released “One Year of Innovation: Taking Action to Improve Care and Reduce Costs” in late January. The report tracks the center’s work with a host of new initiatives in the Affordable Care Act. The center was created by the act to evaluate the efficiency and cost-savings associated with new health care payment and service programs.

The report says the Community-based Care Transitions Program and a related program “has the potential to save 60,000 lives, reduce millions of preventable injuries and complications in patient care and, by meeting its goals, save our health care system as much as $50 billion over 10 years.”

The transitions program will use $500 million to incentivize hospitals, physicians and other medical care providers to reduce hospital readmission rates by partnering hospitals with other care organizations. The goal is to transition Medicare patients to and from a hospital and other health care facilities rather than send patients home without further guidance, which could possibly create a greater risk of a return trip to the hospital.

Return trips to the hospital can increase the risk of infection or other maladies and often costs Medicare and Medicaid more money, according to the center.

Sen. Michael Bennet, D-Colorado, included the transition program in the Affordable Care Act and based the idea on hospital partnerships in Grand Junction and Denver.

“Colorado has shown the country that better-coordinated care and community collaborations can lead to higher-quality outcomes at a much lower cost to patients, hospitals and our health care system as a whole. It’s great to see the Innovation Center moving forward with the important work to bring this successful program to the national level,” Bennet said in a statement.

Bennet drew some of his ideas for the program from Grand Junction-based insurance provider Rocky Mountain Health Plans, which for more than a decade has had its nurses call certain patients 24 to 48 hours after they leave the hospital to make sure they are following doctor’s orders.

Rocky Mountain Health Plans President and Chief Executive Officer Steve ErkenBrack said that policy has helped Grand Junction minimize hospital stays, because it can be hard for people to remember everything they are told when being discharged from the hospital. A follow-up call can ensure people get and take the proper medication and follow other advice, he said.

ErkenBrack said Bennet’s transition program isn’t exactly like the local system, which is done without government incentives. But he said it is key for communities to tailor the program to fit them.

“You can’t dictate a one-size-fits-all model from Washington,” he said. “You can create a program and let communities let it fit their particular needs.”

The transition program has not been tested on a national scale yet. Seven health care regions in Georgia, Ohio, Arizona, Maine, Illinois, New Hampshire and Massachusetts have been selected for a pilot program. Those sites were announced in November.